Notes

p21-Activated Kinase One particular Is actually Permissive to the Bone Muscle tissue Hypertrophy Induced by Myostatin Inhibition.
Given that alteplase has been the only approved thrombolytic agent for acute ischemic stroke for almost two decades, there has been intense interest in more potent and safer agents over the last few years. Tenecteplase is a bioengineered mutation of alteplase with advantageous pharmacodynamics and pharmacokinetics. The superiority of tenecteplase over alteplase has been proven by in vitro and animal studies, and it was approved for use in myocardial infarction more than a decade ago. In patients with acute ischemic stroke, tenecteplase has shown promise in randomized phase II trials and the drug is currently being tested in four phase III clinical trials that will start delivering definite results in the near future NOR-TEST (NCT01949948), TASTE (ACTRN12613000243718), TEMPO-2 (NCT02398656), and TALISMAN (NCT02180204).
To review the literature on femoroacetabular impingement (FAI) treatment outcomes, specifically focusing on potential pre-operative radiographic parameters that may provide prognostic information regarding outcomes following surgical management.

A comprehensive review of computerized literature databases (Medline Ovid and PubMed) was performed, searching for articles reporting on FAI treatment outcomes. A single reviewer screened titles, abstracts and performed full-text reviews of eligible studies. The references of these studies were further screened for additional potentially relevant studies. A total of 243 studies were reviewed, with 18 meeting inclusion criteria.

Thirteen arthroscopic studies reported on 1556 patients, with clinical improvement in 35-92% of patients and associated failure rates of 12-71%. Five open surgical studies reported on 238 patients with clinical improvement in 65-95% of patients and associated failure rates of 0-35%. Both arthroscopic and open studies identified inferior outcomes with pre-operative radiographic findings of an elevated Tönnis grade (grade 2 or higher), joint space <2mm, lateral centre-edge angle (LCEA) <20° and incomplete femoral osteoplasty.

Pre-operative radiographic findings of osteoarthritis (Tönnis grade 2/3, <2mm joint space) or dysplasia (LCEA<20°) should be considered relative contraindications to joint preservation surgery as outcomes are worse among these patients and associated with a higher risk of conversion to total hip arthroplasty. Care should also be taken to perform a thorough femoral osteoplasty to reduce the risk of failure and need for revision surgery.

III.
III.
Hospital readmission is emerging as an important quality measure, yet modifiable predictors of readmission remain unknown. This study was designed to identify risk factors for readmission following revision total knee arthroplasty.

The National Surgical Quality Improvement Program dataset was queried to identify patients undergoing revision total knee arthroplasty from 2011 to 2012. Patient demographics, medical co-morbidities, laboratory values, surgical characteristics and surgical outcomes were examined using bivariate and multivariate logistic regression to identify significant predictors for readmission within 30days of discharge.

There were 108 readmissions (6.2%) among 1754 patients. Risk factors for readmission included a history of transient ischaemic attack/cerebrovascular accident (OR 3.47; 13 95% CI 1.30, 9.25), female sex (OR 1.75, 95% CI 1.15, 2.68) and general anaesthesia (OR 14 1.74, 95% CI 1.09, 2.79). Hypertension treated with medication (OR 0.61, 95% CI 0.39, 0.96) was associated with a lower risk of readmission. Post-operative complications that were significant predictors of hospital readmission included periprosthetic joint infection (OR 15.09, 95% CI 5.57, 40.91), superficial wound infection (OR 16.57, 95% CI 5.82, 47.22) and deep venous thrombosis (OR 8.59, 95% CI 2.36, 31.24).

The preferred use of neuraxial anaesthesia and coordinated discharge planning in patients with a history of transient ischaemic attack/cerebrovascular accident may reduce the risk of readmission following discharge after revision total knee arthroplasty. Additionally, patients with post-operative infections and deep venous thrombosis following these procedures can benefit from close observation in the first weeks following discharge to minimize the likelihood of readmission.

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III.
To measure the distance from the intercondylar ceiling to the lowest point of the medial and lateral femoral condyles in a healthy population so to obtain a clearly discernible and accurate landmark for proper distal femoral resection during total knee arthroplasty (TKA).

Three-dimensional models of the lower extremities of 100 healthy Chinese subjects were constructed using computed tomography scans. The distance between the distal surface of the medial femoral condyle and the intercondylar notch ceiling, in the direction of the femoral mechanical axis, was measured.

The mean distance from the distal surface of the medial femoral condyle to the intercondylar notch ceiling was 9.1±1.4 and 8.2±1.4mm in male and female subjects, respectively. Interestingly, this distance did not differ significantly with varying sizes of the distal femur.

The intercondylar notch ceiling could be used as an accurate landmark to determine the proper distal femoral resection level during TKA. For the clinical relevance, the distal femoral bone cut should be at the level of the intercondylar notch ceiling when using the most of the current TKA prosthesis systems.
The intercondylar notch ceiling could be used as an accurate landmark to determine the proper distal femoral resection level during TKA. For the clinical relevance, the distal femoral bone cut should be at the level of the intercondylar notch ceiling when using the most of the current TKA prosthesis systems.
To compare the clinical outcomes of osteoarthritis indices (WOMAC and Lequesne scores) and adverse events in the treatment of osteoarthritis (OA) of the knee with platelet-rich plasma (PRP) versus hyaluronic acid (HA) or placebo.

A systematic review and meta-regression were performed to compare outcomes between PRP injections versus HA or placebo. Relevant randomized control trials were identified from Medline and Scopus from date of inception to 13 August 2015.

Nine of 551 studies were eligible; 6, 5, 5, 5, 2, 2, 2 and 7 studies were included in pooling of WOMAC total, pain, stiffness and function scores, Lequesne score, IKDC score, EQ-VAS score and adverse events in OA knee patients, respectively. The PRP injections had -15.4 (95% CI -28.6, -2.3, p=0.021), lower mean WOMAC total scores, and 8.83 (95% CI 5.88, 11.78, p<0.001), 7.37 (95% CI 4.33, 10.05, p=0.021) higher mean IKDC and EQ-VAS scores when compared to HA injections. However, PRP injections had no significant differences in WOMAC pain, stiffness and function scores, as well as Lequesne score and adverse events when compared to HA or placebo.

In short-term outcomes (≤1year), PRP injection has improved functional outcomes (WOMAC total scores, IKDC score and EQ-VAS) when compared to HA and placebo, but has no statistically significant difference in adverse events when compared to HA and placebo. This study suggests that PRP injection is more efficacious than HA injection and placebo in reducing symptoms and improving function and quality of life. It has the potential to be the treatment of choice in patients with mild-to-moderate OA of the knee who have not responded to conventional treatment.

I.
I.
The main purpose of the study was to provide an overview of injury mechanisms, concomitant injuries, and other relevant epidemiological data for patients treated in Scandinavia with posterior cruciate ligament reconstruction (PCLR) following a posterior cruciate ligament (PCL) injury.

A total number of 1287 patients who underwent PCLR from 2004 to 2013 in the Scandinavian counties were included from the national ligament registries. The variables such as age, sex, activity, and graft used for reconstruction were collected. Then, injuries were sorted based on concomitant injuries. Finally, data from the different registries were compared.

Average age of the treated patients was 32.7years. Sex distribution ratio of male to female was 858429 (66.7%33.3%). Depending on definition, 26-37% of the injuries treated were isolated PCL injuries. PCL injuries were most commonly encountered in sports with 35.4% of the total number of PCL injuries in the study population. Soccer was the sport with the highest number of injuries (13.1%). Cartilage lesions occurred in 26.1% of PCL injuries and meniscal lesions in 21.0%. Minimum one other additional ligament was injured in 62.2%.

Isolated PCL injuries are common, although the injury is most commonly associated with other ligament injuries. There is a high prevalence of cartilage injuries and meniscal lesions associated with PCL injuries. Sports are the leading cause of PCL injuries treated operatively. Epidemiological data are a necessary part of the basis for injury prevention in the future. The prevalence of concomitant injuries is also relevant and clinically important for the choice of surgical procedure and for the expected outcomes following surgery.

II.
II.Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. find more This method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence V.Phronesis has become a buzzword in contemporary medical ethics. Yet, the use of this single term conceals a number of significant conceptual controversies based on divergent philosophical assumptions. This paper explores three of them on phronesis as universalist or relativist, generalist or particularist, and natural/painless or painful/ambivalent. It also reveals tensions between Alasdair MacIntyre's take on phronesis, typically drawn upon in professional ethics discourses, and Aristotle's original concept. The paper offers these four binaries as a possible analytical framework for classifying and evaluating accounts of phronesis in the medical ethics literature. It argues that to make sense of phronesis as a putative ideal in professional medical ethics--for example, with the further aim of crafting interventions to cultivate phronesis in medical ethics education--the preliminary question of which conception of phronesis is most serviceable for the aim in question needs to be answered. The paper identifies considerable lack of clarity in the current discursive field on phronesis and suggests how that shortcoming can be ameliorated.
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